teenage client

Most therapists I know agree that teenagers can be among the most difficult clients they see in their practice.

They often refuse to attend sessions, refuse to speak when they do attend, swear at parents and therapist, and storm out of the room when they hear things they don’t like. Difficult teenagers often argue head-to-head with adults and professionals using arguments such as, “I’m not going to give them any respect if they don’t give me respect,” and “It’s my life.” At times such teenagers have thrown objects across the office. One particularly aggressive thirteen-year-old girl threw her high heel sandal directly at her therapist while hollering, “I’m glad I’m not one of your kids!”

Some teens are so direct that they come out and say, “There’s nothing you (the therapist) or them (their parents) can do about me.”

Any therapist treating domestic violence takes one look at a husband who is dominating and abusing his wife and recognizes that he exercises power over her. Yet, when a teenager threatens, dominates by shouting and imposing guilt and controls their parents by threatening to run away, most therapists fail to realize that abuse may be going on. Adolescent and preadolescent behavior begins at younger ages as our culture educates them more rapidly. Parents are walking the fine line between being authorities / parents and friends with their children. However, this tightrope is precarious and requires a lot more knowledge and patience than, “spare the rod and spoil the child.” As psychologist David Elkind pointed out decades ago, children are growing up more quickly and losing their childhoods too early in our fast-moving society.

As teenagers become adult-like at earlier ages, they see themselves as “equal” to the adults. Our society isn’t teaching them the distinction between being of equal value versus having equal authority as adults.

Teens are extremely vulnerable to believing that they can handle everything and don’t need adults.

They are struggling to take control of their lives as parents struggle to give them that control only as they’re ready to handle it. There’s a natural power struggle. So, how does an excellent therapist treat a struggle between a teenager and their parents?

Do they ignore the power issues and treat everyone as equals, or understand the need for order in a child’s life through support and leadership? Therapies that advocate support without leadership fail, giving teenagers too much control, in my opinion.

There are four common errors that therapists make with teenagers, that Doré E. Frances, has come across in her practice. They are surprisingly simple to grasp, and they always make matters worse:

Mistake 1: Courting the Teenage Client

Mistake 2: Falling Prey to Therapeutic Tunnel Vision

Mistake 3: Improving Family “Communication”

Mistake 4: Telling Parents to Back Off

We will discuss the first mistake that is often made by inexperienced counselors or weak therapeutic boarding schools. Courting the teenage client can often begin with the initial phone call from a parent.

The first words out of a parent’s mouth often are something like, “The counselor at the school said we need to bring Tammy in for family therapy, but Tammy says we’re the crazy ones and she won’t come in. She said she wouldn’t talk even if she did come in.” In the residential setting, a parent might be concerned that while their teen needs help, he or she would never allow it to happen and would possibly runaway or act out before they could get them to the facility.

This is the number one power tactic teenagers use to keep therapy from happening.

Weak therapists accept this story, suggesting that in order for someone to change they must be willing right from the beginning. They quickly empower the threat of the teen by saying, “oh well I guess there’s nothing to be done when their child won’t cooperate”. When this is the message to your family the therapist might as well say, “Sorry folks, you better get used to your daughter running your family.”

The best therapists, I have come across, when confronting this situation, tell parents on the phone that they treat kids who “won’t cooperate” all the time, and that they, the parents, must decide whether therapy is to happen.

Even in therapeutic boarding schools, teens try to avoid counseling. We recommend that our counselors tell the teen that the session is scheduled and they are expected to be there, and if they are not, the grown-ups will meet anyway. We also coach the parents, who are our clients, to point out to their teen that the adults will be talking about them and making decisions about their life. Most kids come to the first session after hearing this.

When they don’t attend, the therapist agrees with the parents in the first session to change something major at home, and when their adolescent gets angry about the change, to simply say, “Oh, we decided that at the therapy session.”

Teenagers almost always come to the second family session. As long as parents are reactive, and feel helpless and hopeless, the young person wields the power, dominates, controls, and simultaneously suffers. Another way that many therapists court teenage clients and make matters worse, in my opinion, is by according them the same treatment status as adult clients. The prevailing belief–not supported by law–that teenagers are entitled to a confidential relationship with their therapists leaves a teenager who is drunk on power thumbing their nose at the parents. A lot of therapists operate under the same standard of privacy with their teenage clients that they have with adult clients, which they feel requires them to withhold critical information from parents. Many angry parents come to our program with this complaint, stating that their teen’s therapist was withholding important facts, such as the teen’s sexual activity, smoking, drugs or criminal behavior, from them. Confidentiality in families is held within the family and not by individual members. Therefore, the therapist has latitude to share whatever needs to be shared.

The best therapists make it clear that they are closely involved with parents and they will use their judgment as to what they share with them.

After all, what’s the point of a teenager telling a therapist they are using drugs when the therapist can’t help the teen discuss it with the parents and find a solution? Creative therapists invite teens to withhold information from them until they decide they can be trusted. I find that teens then share sensitive information with their therapist even though they don’t give them a guarantee of confidentiality.